COMPLICATIONS      C.S.O.M.Dr. Mohammad Aslam Chaudhry     Professor E.N.T (BBH)
Anatomical review
“Medial wall of middle ear”
Surgeon’s view
Complications of CSOM• classification  1. Cranial (Intra-temporal )  2. Extra-cranial complications  3. Intra-cranial comp...
Pre-disposing factors•   Age•   Virulent organisms•   Cholesteatoma or Bone erosion•   Presence of a congenital dehiscence...
Routes of spread
Pathways of infections• The commonest way for extension of  infection is by bone erosion due to a  cholesteatoma.• Vascula...
COMPLICATIONS OF CSOM    Routs of spread
Cranial complications            (Intratemporal )1.   Mastoiditis2.   Petrositis3.   Labyrinthitis4.   Facial paralysis5. ...
Mastoiditis•    Inflammation of mastoid air cells•    Acute vs Chronic•    Fever•    2 weeks after OM•   Earache•   Irrita...
Labyrinthitis•   • Infection of the inner ear•   • SNHL•   • Vertigo•   • Nausea and vomiting
labyrinthitis
Tympanosclerosis•   Asymptomatic•   Indicator of OM•   Ear drum stiffness•   Ossicular fixation
Tympanosclerosis
• 56 yr    • Earache• Chronic Discharge
Facial Paralysis• Slow – chronic expansion of disease• Rapid – infected cholesteatoma• With cholesteatoma requires immedia...
Facial ParalysisManagement• Mastoidectomy, Remove cholesteatoma and  infected debris• IV antibiotics and  +/- steroids.
Petrositis•   Only in pneumatised petrous pyramids•   Infected petrous cells•   Poor drainage•   Bony coalescence → symptoms
• GRADENIGO• Retro-orbital pain• Abducent→  Diplopia• Discharge
Extra-cranial complications•   Otitis externa•   Cervical lymphadenitis•   Retropharyngeal &•   Parapharyngeal abscesses
Impending sign @ symptoms• Decreased mental status• Stiff neck• Ataxia• Visual changes• Seizures• Other  Headache, letharg...
INTRACRANIAL COMLICATIONS• Barriers penetration1. Bone→ Epidural Abscess→ LST2. Dura Mater→ Subdural Abscess3. Arachnoid→M...
COMPLICATIONS OF CSOM
Lateral Sinus Thrombosis (sigmoid sinus)Spread of infection by direct extension orvia mastoid emissary vein               ...
Signs of LST• Picket-fence fever 􀃆• Papilledema• Torticollis• Greisinger sign →
LST•   LST is rare complication•   CT•   Angiography•   MRI- MRV
LST ……Treatment• Empiric broad coverage until C&S• antibiotic with good CSF penetration• Surgery  – Mastoidectomy  – Decom...
Intracranial Epidural Abscess• Localized between dura  and bone• dural adherence to bone  at suture lines• Focal osteomyel...
Subdural Abscess• Between the dura and  the arachnoid.• Potential space• Lack of anatomical  boundaries→ spread rapidly• E...
Subdural Abscess - clinical• Fever• Focal neurological deficit• Headache• Seizures• Forehead or eye swelling from  emissar...
Subdural Abscess - evaluation• CT of head both with and without contrast• LP - hazardous - risk of transtentorial  herniat...
Meningitis
Meningitis: Clinical Manifestations•   Headache•   Nuchal rigidity•   Fever and chills•   Photophobia•   Vomiting•   Seizu...
Physical ExaminationKernig & Brudzinski signs have low sensitivity but high specificity
Brain Abscess - Clinical                Presentation•   non-specific Symptoms for abscess•   increased intracranial pressu...
Otic hydrocephalusSymptoms• Non-specific• Headache• Tinnitus• Nausea / vomiting• Visual disturbance• Others – lethargy, di...
TX• Decrease the IC pressure  – Corticosteriods  – Acetazolamide  – Lumbar pucture• I/V Antibiotics• Mastoidectomy
THANK YOU
Complications of suppurative otitis media
Complications of suppurative otitis media
Complications of suppurative otitis media
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Complications of suppurative otitis media

  1. 1. COMPLICATIONS C.S.O.M.Dr. Mohammad Aslam Chaudhry Professor E.N.T (BBH)
  2. 2. Anatomical review
  3. 3. “Medial wall of middle ear”
  4. 4. Surgeon’s view
  5. 5. Complications of CSOM• classification 1. Cranial (Intra-temporal ) 2. Extra-cranial complications 3. Intra-cranial complications
  6. 6. Pre-disposing factors• Age• Virulent organisms• Cholesteatoma or Bone erosion• Presence of a congenital dehiscence• Obstruction of drainage e.g polyp• Low resistance of the patient• Poor socio-economic status
  7. 7. Routes of spread
  8. 8. Pathways of infections• The commonest way for extension of infection is by bone erosion due to a cholesteatoma.• Vascular extension (retrograde thrombophlebitis). • Extension along preformed pathways as– Congenital dehiscences, fracture lines, round window membrane, the labyrinth,– Dehiscences due to previous surgery.
  9. 9. COMPLICATIONS OF CSOM Routs of spread
  10. 10. Cranial complications (Intratemporal )1. Mastoiditis2. Petrositis3. Labyrinthitis4. Facial paralysis5. Perilymphatic fistula
  11. 11. Mastoiditis• Inflammation of mastoid air cells• Acute vs Chronic• Fever• 2 weeks after OM• Earache• Irritability
  12. 12. Labyrinthitis• • Infection of the inner ear• • SNHL• • Vertigo• • Nausea and vomiting
  13. 13. labyrinthitis
  14. 14. Tympanosclerosis• Asymptomatic• Indicator of OM• Ear drum stiffness• Ossicular fixation
  15. 15. Tympanosclerosis
  16. 16. • 56 yr • Earache• Chronic Discharge
  17. 17. Facial Paralysis• Slow – chronic expansion of disease• Rapid – infected cholesteatoma• With cholesteatoma requires immediate surgery• CT localizes involved portion
  18. 18. Facial ParalysisManagement• Mastoidectomy, Remove cholesteatoma and infected debris• IV antibiotics and +/- steroids.
  19. 19. Petrositis• Only in pneumatised petrous pyramids• Infected petrous cells• Poor drainage• Bony coalescence → symptoms
  20. 20. • GRADENIGO• Retro-orbital pain• Abducent→ Diplopia• Discharge
  21. 21. Extra-cranial complications• Otitis externa• Cervical lymphadenitis• Retropharyngeal &• Parapharyngeal abscesses
  22. 22. Impending sign @ symptoms• Decreased mental status• Stiff neck• Ataxia• Visual changes• Seizures• Other Headache, lethargy, fever.
  23. 23. INTRACRANIAL COMLICATIONS• Barriers penetration1. Bone→ Epidural Abscess→ LST2. Dura Mater→ Subdural Abscess3. Arachnoid→Meningitis4. Pia Mater→ Brain Abscess
  24. 24. COMPLICATIONS OF CSOM
  25. 25. Lateral Sinus Thrombosis (sigmoid sinus)Spread of infection by direct extension orvia mastoid emissary vein ↓ Pus and granulation adjacent to sigmoidsinus ↓ Reactive thrombophlebitis ↓ intraluminal thrombus ↓ CSF obstruction
  26. 26. Signs of LST• Picket-fence fever 􀃆• Papilledema• Torticollis• Greisinger sign →
  27. 27. LST• LST is rare complication• CT• Angiography• MRI- MRV
  28. 28. LST ……Treatment• Empiric broad coverage until C&S• antibiotic with good CSF penetration• Surgery – Mastoidectomy – Decompression – Thrombus evacuation
  29. 29. Intracranial Epidural Abscess• Localized between dura and bone• dural adherence to bone at suture lines• Focal osteomyelitis• Management and etiology same as subdural empyema
  30. 30. Subdural Abscess• Between the dura and the arachnoid.• Potential space• Lack of anatomical boundaries→ spread rapidly• Ear 14%• (paranasal sinusitis 75%)
  31. 31. Subdural Abscess - clinical• Fever• Focal neurological deficit• Headache• Seizures• Forehead or eye swelling from emissary vein thrombosis• Vomiting
  32. 32. Subdural Abscess - evaluation• CT of head both with and without contrast• LP - hazardous - risk of transtentorial herniation
  33. 33. Meningitis
  34. 34. Meningitis: Clinical Manifestations• Headache• Nuchal rigidity• Fever and chills• Photophobia• Vomiting• Seizures• Focal neurologic symptoms• Altered sensorium (confusion, delirium, or declining level of consciousness)
  35. 35. Physical ExaminationKernig & Brudzinski signs have low sensitivity but high specificity
  36. 36. Brain Abscess - Clinical Presentation• non-specific Symptoms for abscess• increased intracranial pressure• –Headache,• –Nausea/Vomiting• – Lethargy.• – Seizures.
  37. 37. Otic hydrocephalusSymptoms• Non-specific• Headache• Tinnitus• Nausea / vomiting• Visual disturbance• Others – lethargy, dizziness, mood change
  38. 38. TX• Decrease the IC pressure – Corticosteriods – Acetazolamide – Lumbar pucture• I/V Antibiotics• Mastoidectomy
  39. 39. THANK YOU

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